In April 2025, S&P Global Ratings maintained 27 ratings and took four positive rating actions on U.S. not-for-profit health care providers. In addition, we revised two outlooks favorably.
There were no downgrades or unfavorable outlook revisions in April.
We also assigned ratings to 14 new debt issuances for nine systems, four stand-alone hospitals, and one long-term-care facility.
The six rating actions and outlook revisions consisted of the following:
- Four upgrades on three systems and one stand-alone hospital to the 'A' category and higher, of which three were related to mergers and acquisitions;
- One outlook revision to positive from stable on a stand-alone hospital, based on a definitive agreement to merge with a higher-rated system; and
- One outlook revision to stable from negative on a long-term-care facility.
Chart 1
Chart 2
April 2025, U.S. not-for-profit health care rating actions | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
State | Rating | Outlook | Entity Type | Action | Description | |||||||||
Adena Health System |
OH | A- | Negative | Stand-alone | Maintained; New sale | Credit quality consistent with existing rating | ||||||||
Blessing Hospital |
IL | A | Stable | Stand-alone | Maintained | Credit quality consistent with existing rating | ||||||||
Bon Secours Mercy Health* |
MD | A+ | Stable | System | Maintained; New sale | Credit quality consistent with existing rating | ||||||||
Brown University Health |
RI | BBB+ | Stable | System | Maintained; New sale | Credit quality consistent with existing rating | ||||||||
Cedars-Sinai Health System |
CA | AA- | Stable | System | Maintained | Credit quality consistent with existing rating | ||||||||
CommonSpirit Health |
CO | A- | Stable | System | Maintained | Credit quality consistent with existing rating | ||||||||
Community Foundation of Northwest Indiana |
IN | AA- | Stable | System | Maintained | Credit quality consistent with existing rating | ||||||||
Corewell Health |
MI | AA | Stable | System | Maintained; New sale | Credit quality consistent with existing rating | ||||||||
Corewell Health* |
MI | AA | Stable | System | Maintained; New sale | Credit quality consistent with existing rating | ||||||||
Dartmouth Health |
NH | A | Stable | System | Maintained; New sale | Credit quality consistent with existing rating | ||||||||
Denver Health and Hospital Authority |
CO | BBB | Stable | Stand-alone | Maintained; New sale | Credit quality consistent with existing rating | ||||||||
Doylestown Hospital |
PA | AA- | Stable | Stand-alone | Upgrade | Affiliation with University of Pennsylvania Health System and application of GRM criteria | ||||||||
Ector County Hospital District |
TX | BBB- | Stable | Stand-alone | Maintained | Credit quality consistent with existing rating | ||||||||
Greater Fairbanks Community Hospital Foundation |
AK | A | Stable | Stand-alone | Maintained | Credit quality consistent with existing rating | ||||||||
Henry County Health Care Authority |
AL | BB+ | Stable | Long-term care | Favorable outlook revision | Improved cash flows led to strengthened MADS coverage and expected breakeven results | ||||||||
Jennie Stuart Medical Center |
KY | BBB- | Positive | Stand-alone | Favorable outlook revision | Definitive agreement to affiliate with Deaconess Health System | ||||||||
Legacy Health |
OR | A | Stable | System | Maintained | Credit quality consistent with existing rating | ||||||||
Marshfield Clinic |
WI | A | Stable | System | Upgrade | Merger with Sanford Health and application of GRM criteria | ||||||||
Masonic Villages of the Grand Lodge of Pennsylvania |
PA | A | Stable | Long-term care | Maintained; New sale | Credit quality consistent with existing rating | ||||||||
Mayo Clinic* |
MN | AA | Stable | System | Maintained; New sale | Credit quality consistent with existing rating | ||||||||
Memorial Sloan Kettering Cancer Center |
NY | AA- | Stable | Stand-alone | Maintained; New sale | Credit quality consistent with existing rating | ||||||||
Meritus Health |
MD | A- | Stable | Stand-alone | Maintained; New sale | Credit quality consistent with existing rating | ||||||||
North Broward Hospital District |
FL | A+ | Stable | System | Upgrade | Trend of robust operating performance and improved balance sheet with meaningful tax support | ||||||||
Novant Health* |
NC | A+ | Stable | System | Maintained; New sale | Credit quality consistent with existing rating | ||||||||
Ochsner Health System |
LA | A | Stable | System | Maintained; New sale | Credit quality consistent with existing rating | ||||||||
OSF Healthcare System |
IL | A | Stable | System | Maintained | Credit quality consistent with existing rating | ||||||||
Providence St. Joseph Health |
WA | A | Negative | System | Maintained | Credit quality consistent with existing rating | ||||||||
Saint Lukes University Health Network |
PA | A- | Stable | System | Maintained | Credit quality consistent with existing rating | ||||||||
Salem Health |
OR | A+ | Stable | Stand-alone | Maintained | Credit quality consistent with existing rating | ||||||||
Temple University Health System |
PA | BBB | Stable | System | Maintained | Credit quality consistent with existing rating | ||||||||
University Health System |
TN | BBB | Negative | Stand-alone | Maintained | Credit quality consistent with existing rating | ||||||||
Virginia Mason Medical Center |
WA | A- | Stable | System | Upgrade | Note substitution with debt now secured by CommonSpirit Health | ||||||||
Wellstar Health System* |
GA | A+ | Stable | System | Maintained; New sale | Credit quality consistent with existing rating | ||||||||
*These actions relate solely to assignment of ratings on variable rate demand bonds (VRDBs) or commercial paper (Novant Health) following reviews completed earlier. MADS--Maximum annual debt service. GRM--Group Rating Methodology. |
This report does not constitute a rating action.
Primary Credit Analyst: | Blake C Fundingsland, Englewood + 1 (303) 721 4703; blake.fundingsland@spglobal.com |
Secondary Contacts: | Cynthia S Keller, Augusta + 1 (212) 438 2035; cynthia.keller@spglobal.com |
Suzie R Desai, Chicago + 1 (312) 233 7046; suzie.desai@spglobal.com | |
Amy He, New York +1 2124380381; amy.he@spglobal.com |
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